Provider Demographics
NPI:1467118315
Name:COUNTRY ROADS HOSPICE
Entity Type:Organization
Organization Name:COUNTRY ROADS HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:VAWN
Authorized Official - Last Name:BAILEY-SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-866-8913
Mailing Address - Street 1:53 WEY BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-4801
Mailing Address - Country:US
Mailing Address - Phone:770-866-8913
Mailing Address - Fax:
Practice Address - Street 1:53 WEY BRIDGE CT
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:GA
Practice Address - Zip Code:30184-4801
Practice Address - Country:US
Practice Address - Phone:770-866-8913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based